| NPI | 1992862163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: NY C005104-1) |
| Additional Taxonomies | 156FC0800X Technician/Technologist Contact Lens (Licence: NY C005104-1) |
| 156FC0801X Technician/Technologist Contact Lens Fitter (Licence: NY C005104-1) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2011-09-21 |