| NPI | 1760043863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 34430) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 009050) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2020-08-03 |