| NPI | 1184685752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA1726) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12264T) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-10-05 |