NPI | 1063594364 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC002340) |
Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: FL OPC002340) |
Enumeration Date | 2006-10-19 |
Last Update Date | 2023-08-10 |