| NPI | 1336471440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: CA OPT12461TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT12461TPA) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA OPT12461TPA) | |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2010-02-01 |