| NPI | 1417055344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT13238TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV006796-1) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2021-10-23 |