| NPI | 1700842739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6670 T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12765 T) |
| 152W00000X Optometrist (Licence: VA 0618001554) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2013-03-28 |