| NPI | 1699749697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 05920T) |
| Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: CA OPT 05920T) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2007-07-09 |