| NPI | 1417936220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 34812) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1265) |
| 152W00000X Optometrist (Licence: AK 180380) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2022-01-04 |