| NPI | 1669511713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT5271T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 5271T) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2008-04-22 |