| NPI | 1497803886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: HI OD-928) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11019T) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2021-03-22 |