| NPI | 1255324042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 7946T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 1688) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2014-10-31 |