| NPI | 1942379664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 5370 TPA) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: CA OPT 5370 TPA) |
| 152WS0006X Optometrist, Sports Vision (Licence: CA OPT 5370 TPA) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: CA OPT 5370 TPA) | |
| 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: CA OPT 5370 TPA) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2008-01-03 |