| NPI | 1679543821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT6288TPL) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA OPT6288TPL) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2009-02-20 |