| NPI | 1407046386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13265) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA ML1792058) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2008-09-24 |