| NPI | 1174645139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: HI 401) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 10263) |
| 152W00000X Optometrist (Licence: VA 0618001551) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2016-12-27 |