| NPI | 1902353238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 34111) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 894) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2026-04-28 |