| NPI | 1073962163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33390) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CA 33390) |
| 152WP0200X Optometrist Pediatrics (Licence: CA 33390) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2016-06-09 |