| NPI | 1124540489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33927TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 934) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2023-09-26 |