| NPI | 1588975056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2636) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13931) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2010-10-04 |