| NPI | 1104807809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 6373TPL) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 6373TLG) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2015-06-25 |