| NPI | 1073192100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 34773) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT34773TLG) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2022-11-11 |