| NPI | 1548379613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13241TLG) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IL 046009527) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2025-01-23 |