| NPI | 1134560477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14879 TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007985) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2021-11-01 |