| NPI | 1386851905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 7968TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: HI 206) |
| 152W00000X Optometrist (Licence: CA 7968) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2021-10-21 |