| NPI | 1750874608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33952) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: CA 33952) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 33952) | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2018-12-19 |