| NPI | 1023030301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G74387) |
| Additional Taxonomies | 156FX1100X Technician/Technologist, Ophthalmic (Licence: CA G74387) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2011-05-06 |