| NPI | 1811024516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WX0102X Optometrist Occupational Vision (Licence: CA OPT6576T) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CA OPT6576T) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2015-08-05 |