| NPI | 1114369709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 15363T) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: CA 15363T) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2019-12-19 |