| NPI | 1912075672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 8353T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 8353) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-11-29 |