| NPI | 1265510739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2784) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA CA12426T) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-04-17 |