| NPI | 1518638816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 43804) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 35375) |
| 156F00000X Technician/Technologist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-09-26 |
| Last Update Date | 2023-05-29 |