NPI | 1750636163 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 14402 TLG) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA OPT 14402 TLG) |
152WV0400X Optometrist, Vision Therapy (Licence: CA OPT 14402 TLG) | |
Enumeration Date | 2012-07-23 |
Last Update Date | 2018-11-09 |