| NPI | 1952394959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 5908T) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: CA 5908T) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2013-05-14 |