| NPI | 1194824789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC1521) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: FL OPC1521) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2011-02-01 |