| NPI | 1669751095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14289TLG) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CA 14289TLG) |
| 152WP0200X Optometrist Pediatrics (Licence: CA 14289TLG) | |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2019-04-04 |