| NPI | 1225652308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35925) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 1057) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2025-04-07 |