| NPI | 1073035028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 37458TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008663) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2024-09-13 |