| NPI | 1710035068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 06920T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 270A00377600) |
| 152W00000X Optometrist (Licence: PA OE005239P) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA 06920T) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2015-11-22 |