| NPI | 1013045368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002431) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12991T) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2009-01-12 |