| NPI | 1952894487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT33883-TLG) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA OPT33883-TLG) |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2019-10-18 |