| NPI | 1841552940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: HI 746) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14392) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2021-12-07 |