| NPI | 1164638169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 520) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12585T) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |