| NPI | 1689770489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT8873TPG) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: CA OPT8873TPG) |
| 152WV0400X Optometrist Vision Therapy (Licence: CA OPT8873TPG) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2016-10-27 |