| NPI | 1972551034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: SC 262) |
| Additional Taxonomies | 156FC0800X Technician/Technologist, Contact Lens (Licence: SC 50) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2012-01-12 |