NPI | 1699749697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
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 |