| NPI | 1952378010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 8210T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: HI 220) |
| 152WV0400X Optometrist, Vision Therapy (Licence: CA 8210T) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2014-01-22 |