| NPI | 1174663033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 12988 TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4554) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2015-08-13 |