| NPI | 1487316550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35135) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 1114) |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2022-06-08 |