| NPI | 1649385378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT12244) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 1290) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2018-05-18 |