| NPI | 1528188596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AK 061) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 4352) |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2007-07-09 |