| NPI | 1982155701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT33865TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 1839-773AT) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2019-09-11 |