| NPI | 1447549514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35553) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CA 25351) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2023-07-05 |