| NPI | 1386729721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 11209657-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11462) |
| 152W00000X Optometrist (Licence: NV 514) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2020-12-30 |