| NPI | 1225165590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 5564 TPL) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 5564T) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2012-01-12 |