| NPI | 1740650043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0003640) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5122) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2025-05-14 |