| NPI | 1558343905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT7215TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT 00007215 TPA) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2011-10-28 |