| NPI | 1053084210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35600-TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV009388) |
| Enumeration Date | 2021-07-25 |
| Last Update Date | 2024-10-25 |