| NPI | 1053496448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV NV168) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 1015) |
| 152W00000X Optometrist (Licence: CA OPT7580) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2007-12-07 |