| NPI | 1346640976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 15357TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5046) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2024-04-25 |