| NPI | 1568813434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT34978TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011029) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2021-11-12 |