| NPI | 1316179252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT14557) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007487) |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2018-03-17 |