| NPI | 1134103393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 557) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11887T) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2012-04-26 |