| NPI | 1881033751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 0003575) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ND 708) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: ND 708) | |
| 152WS0006X Optometrist, Sports Vision (Licence: ND 708) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR 152W00000X) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2021-08-18 |