| NPI | 1407052582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 2232) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13245) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2020-07-04 |