| NPI | 1043206022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G61288) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA G61288) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2018-04-19 |