| NPI | 1801636147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OD36103) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 1197) |
| Enumeration Date | 2024-05-24 |
| Last Update Date | 2025-08-27 |