| NPI | 1972574614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: CA 12008T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12008T) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2016-09-01 |