| NPI | 1548365562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13897TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 2299) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2019-03-29 |