| NPI | 1922140078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13176-T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 1266) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |