| NPI | 1811037872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 12252 TPL) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP1000127) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |