| NPI | 1760412845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 12688T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 4037TX) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2009-03-27 |