| NPI | 1013270586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14560) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY tuv007857) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2023-04-25 |