| NPI | 1306036421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13657) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5720) |
| 152W00000X Optometrist (Licence: VA 0618001899) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2014-06-18 |