| NPI | 1790970812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13286) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 13286T) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2012-08-15 |