| NPI | 1568442911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 12468T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00603200) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2025-12-04 |