| NPI | 1053752907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC-4823) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100289) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: ID ODP-100289) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC-4823) | |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2020-12-15 |