| NPI | 1598171027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT34604) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008191) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2025-04-14 |