| NPI | 1124192620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA bol5070) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA opt 9702) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2008-05-16 |