| NPI | 1285208546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT35541-TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT.0003672) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2023-09-27 |