| NPI | 1427459486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 15410) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2379) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2016-11-04 |