| NPI | 1174555619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OP 1617) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: FL OP 1617) |
| 152WP0200X Optometrist Pediatrics (Licence: FL OP 1617) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2009-03-20 |