| NPI | 1003940453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13892T) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA OPT13892TPA) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MD TA2019) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: DC OP2000527) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: VA 0618001819) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2022-10-24 |