| NPI | 1225527153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33945) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 2237) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2018-08-07 |