| NPI | 1164685194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13481) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007498) |
| 152W00000X Optometrist (Licence: AZ 001797) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2016-11-22 |