| NPI | 1790854958 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 10145T) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 10145TLG) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2021-09-13 |