| NPI | 1679020283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33506 TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ZZ GOC 01-20989) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2019-11-01 |