| NPI | 1376924779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0004183) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 15248) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2026-07-08 |