| NPI | 1417934316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT-110408LTG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT11408T) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2010-10-20 |