| NPI | 1770260200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0004020) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA OPT35478-TLG) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2024-07-22 |