| NPI | 1649947391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA OPT34970) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 12449720-9934) |
| 152W00000X Optometrist (Licence: FL OPFC103) | |
| Enumeration Date | 2021-08-29 |
| Last Update Date | 2022-12-02 |