| NPI | 1568183440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 3975) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 35253) |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2026-07-09 |