| NPI | 1922597269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33901TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 961) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2021-12-06 |