| NPI | 1073917068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 15140) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CA 15140) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: CA 15140) | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2014-10-20 |