| NPI | 1336230572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT34731-TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 06489T) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-01-06 |