| NPI | 1124057351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 7275T) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA OPT7275TPG) |
| 152WP0200X Optometrist, Pediatrics (Licence: CA OPT7275TPG) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2016-10-25 |