| NPI | 1609936558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35433) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL opc1771) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2026-02-18 |