| NPI | 1679677033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13402) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4579) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2022-01-03 |