| NPI | 1417288184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: HI 849) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13752) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2017-09-19 |