| NPI | 1578530119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV NV175) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 6745) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2007-10-04 |