| NPI | 1225324023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 896) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14157TLG) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2020-10-16 |