| NPI | 1467444844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT6405TPA) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA OPT6405TPA) |
| 152WX0102X Optometrist, Occupational Vision (Licence: CA OPT6405TPA) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2009-07-24 |