| NPI | 1386181865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33648) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: CA 33648-TLG) |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2023-10-21 |