| NPI | 1083694285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2631) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12219T) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2014-06-12 |