| NPI | 1851585624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13702) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV0071931) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2011-09-16 |