| NPI | 1366463192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT09532T) |
| Additional Taxonomies | 152WX0102X Optometrist Occupational Vision (Licence: CA OPT09532T) |
| 156FC0801X Technician/Technologist Contact Lens Fitter (Licence: CA OPT09532T) | |
| 156FX1900X Technician/Technologist Orthoptist (Licence: CA OPT09532T) | |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: CA OPT09532T) | |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: CA OPT09532T) | |
| 152WP0200X Optometrist Pediatrics (Licence: CA OPT09532T) | |
| 152WS0006X Optometrist Sports Vision (Licence: CA OPT09532T) | |
| 152WV0400X Optometrist Vision Therapy (Licence: CA OPT09532T) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2022-02-11 |