| NPI | 1801885132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 6476t) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 6476T) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2025-09-11 |