| NPI | 1407337439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 34493TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008867) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2021-12-10 |