| NPI | 1073550976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 5224T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 5224T) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2008-12-01 |