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 |