| NPI | 1922569938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT34640) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002373) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2021-12-08 |