| NPI | 1417243205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 14147) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14147) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2017-02-21 |