| NPI | 1831377217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13067T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 571) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2010-07-15 |