| NPI | 1649754748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9578T) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA 35898TLG) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2025-05-08 |