| NPI | 1871584581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT5933TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 5933) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2010-08-20 |