| NPI | 1568777076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14584) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2947) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TN 2947) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2013-10-23 |