| NPI | 1396767687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 11610T) |
| Additional Taxonomies | 156FX1700X Technician/Technologist, Ocularist (Licence: CA 11610T) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2020-04-26 |