| NPI | 1013205228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14536 TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 705) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2021-12-22 |