| NPI | 1891177895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 154141TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003067) |
| 152W00000X Optometrist (Licence: WA 60709969) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2023-07-14 |