| NPI | 1730260894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 7911T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 1057) |
| 152W00000X Optometrist (Licence: CA 7911) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2009-01-21 |