| NPI | 1891136941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1969) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14674) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2021-05-13 |