| NPI | 1982746343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 10190T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 2464) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |