| NPI | 1306220082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 878) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 15261) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2022-07-21 |