| NPI | 1134574783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT33418TLG) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA 33418TLG) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2025-12-10 |