| NPI | 1306903067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: CA OPT 12975) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12975t) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2022-04-22 |