| NPI | 1043575228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: FL 4783) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 7991TG) |
| 152W00000X Optometrist (Licence: FL 4783) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL 4783) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: FL 4783) | |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2019-09-20 |