| NPI | 1962649954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2424) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11027T) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2014-07-08 |