| NPI | 1518952498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT8948T) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: CA OPT8948T) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2008-10-29 |