| NPI | 1639509987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: HI 785) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14802) |
| Enumeration Date | 2013-11-23 |
| Last Update Date | 2019-01-25 |