| NPI | 1376959395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 15094TLG) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA 15094TLG) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2016-02-08 |