| NPI | 1194878926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 11627T) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: CA HA 7650) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2015-06-23 |