| NPI | 1760153845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 3228) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT35120-TLG) |
| 152W00000X Optometrist (Licence: CT Student) | |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2022-07-26 |