| NPI | 1609851344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 8651 TPL) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002985) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2022-04-08 |