| NPI | 1538246335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT00006004TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 06004T) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2017-07-17 |