| NPI | 1568554640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: HI OD-874) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT12499TPL) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2021-05-12 |