| NPI | 1740776038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 4442ATI) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 33972) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2021-07-28 |