| NPI | 1992844062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 8324T) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CA 8324T) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2010-11-03 |