| NPI | 1790185932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 975) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 15099) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2020-02-26 |