| NPI | 1679542989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 10049T) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 10049T) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2012-10-30 |