| NPI | 1477525608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OP6214T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA MF0730970) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2011-01-17 |