| NPI | 1477121713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT34988-TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV009413-01) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2023-03-22 |