| NPI | 1962600775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 2326) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT13290T) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2022-06-14 |