| NPI | 1013460062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5259) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: FL 5259) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: FL 5259) | |
| 152WS0006X Optometrist Sports Vision (Licence: FL 5259) | |
| 152WV0400X Optometrist Vision Therapy (Licence: FL 5259) | |
| 152WX0102X Optometrist Occupational Vision (Licence: FL 5259) | |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2020-06-03 |