| NPI | 1255426912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100178) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13076 T) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-06-10 |