| NPI | 1588653752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 6943 TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2000145741) |
| 152W00000X Optometrist (Licence: TX 2555T) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2015-05-29 |