| NPI | 1093259459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1100X Technician/Technologist, Ophthalmic (Licence: FL ME12188) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO1290) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2016-12-05 |