| NPI | 1942211792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2513T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13570T) |
| 152W00000X Optometrist (Licence: OR 2513ATI) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2024-05-29 |