| NPI | 1508152281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14181) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: CA 14181) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2024-07-01 |