| NPI | 1366484115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: CA 11127T) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA 11127T) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2021-11-17 |