| NPI | 1952076697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35144) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 10377T) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2023-10-01 |