| NPI | 1619947108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA CA05902T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AR 5902T) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2011-11-21 |