| NPI | 1912254731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT14502TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ AZ1902) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2015-06-21 |