| NPI | 1376906784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT33511-TLG) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA OPT33511-TLF) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA OPT33511-TLG) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2021-10-28 |