| NPI | 1104997386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC3967) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: GA OPT002078) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA OPT12210) | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2007-07-08 |