| NPI | 1841286176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 1709) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 6938) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2008-10-27 |