| NPI | 1033663109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OD12245) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12245) |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2019-10-22 |