| NPI | 1124216098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT13300TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007638-1) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2012-10-19 |