| NPI | 1770747701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 13654) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2062) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2012-02-28 |