| NPI | 1912937251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 09431T) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 09431T) |
| 152WP0200X Optometrist, Pediatrics (Licence: CA 09431T) | |
| 152WS0006X Optometrist, Sports Vision (Licence: CA 09431T) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: CA 09431T) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2013-02-05 |