| NPI | 1669465035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 11354TPL) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC3895) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2014-09-05 |