| NPI | 1861844680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33381) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA ca298165) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2021-02-12 |