| NPI | 1922078583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 11597T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 3677) |
| 152W00000X Optometrist (Licence: OR 2912AT) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2019-02-27 |