| NPI | 1962176099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT36113-TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00707900) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2026-01-02 |