| NPI | 1194752170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3161AT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 5776T) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2016-10-13 |