| NPI | 1114661386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35199) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011634) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 35199) | |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2023-10-31 |