| NPI | 1013929520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002197) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT13677T) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2021-08-25 |