| NPI | 1952360182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 6600T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-594) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2013-10-08 |