| NPI | 1962471664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 07675 TPA) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 07675 TPA) |
| 152WP0200X Optometrist, Pediatrics (Licence: CA 07675 TPA) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2009-04-17 |