| NPI | 1407867161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 0PT13129T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13129) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2008-12-23 |