| NPI | 1255783106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 34420TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2544) |
| Enumeration Date | 2016-07-04 |
| Last Update Date | 2023-05-30 |