| NPI | 1457825788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 34168TLG) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E126646) |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2021-05-03 |