| NPI | 1053365254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 11839 TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11839T) |
| 152W00000X Optometrist (Licence: OR 2833T) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2023-03-17 |