| NPI | 1285798504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14381) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007083) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2023-05-31 |