| NPI | 1659344802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 10496T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 3217) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2018-03-09 |