| NPI | 1740438506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13624) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60033593) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2012-02-14 |