| NPI | 1659487866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13415 T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007090) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2011-12-13 |