| NPI | 1245222934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2006) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL opc2006) |
| 152WX0102X Optometrist, Occupational Vision (Licence: FL opc2006) | |
| 156FC0800X Technician/Technologist, Contact Lens | |
| 156FC0801X Technician/Technologist, Contact Lens Fitter | |
| 156FX1201X Technician/Technologist, Optometric Assistant | |
| 156FX1800X Technician/Technologist, Optician | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2007-09-19 |