| NPI | 1194721001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL op1839) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL opc1839) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2012-08-01 |