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 |