| NPI | 1437297173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 8551 TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 8551) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2017-03-31 |