| NPI | 1275684409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 6340T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100504) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2024-07-26 |