| NPI | 1922041904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G24340) |
| Additional Taxonomies | 156FX1100X Technician/Technologist, Ophthalmic (Licence: CA G24340) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-03-29 |