| NPI | 1003420399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2620) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 34666) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2020-09-03 |