| NPI | 1669576716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT5607TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT 5607 TPA) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2013-06-05 |