| NPI | 1790976066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13477T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2533) |
| 152W00000X Optometrist (Licence: OR 3257ATI) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2011-09-19 |