| NPI | 1376929034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT33893TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5108) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2022-02-10 |