| NPI | 1568990901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP1000371) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 35066) |
| 152W00000X Optometrist (Licence: VA 0618002563) | |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2022-08-18 |