| NPI | 1144654047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14854) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008068) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2023-01-20 |