| NPI | 1710609516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT35874-TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 12989955-9934) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2024-12-13 |