| NPI | 1760462956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 9831T) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CA 9831T) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: CA 9831 TPA) | |
| 152WS0006X Optometrist Sports Vision (Licence: CA 9831T) | |
| 152WX0102X Optometrist Occupational Vision (Licence: CA 9831T) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2013-05-21 |