| NPI | 1205940889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 5036 TPA) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 5036 TPA) |
| 152WS0006X Optometrist, Sports Vision (Licence: CA 50360 TPA) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: CA 5036 TPA) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-03-07 |