| NPI | 1518994235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14880) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2252T) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2015-07-29 |