| NPI | 1134103484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA OPT8787T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 8787) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2019-10-10 |