| NPI | 1952021669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35331) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 10674) |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2024-05-22 |