| NPI | 1043856487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 11555545-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 34461TLG) |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2020-11-16 |