| NPI | 1366472938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 12847 TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 1510) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2023-03-07 |