| NPI | 1790291565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33869) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CA 33869) |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2018-09-25 |