| NPI | 1043731557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT34165-TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3589) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2019-07-23 |