| NPI | 1255547295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2587) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: FL OPC2587) |
| 152WX0102X Optometrist Occupational Vision (Licence: FL OPC2587) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2016-05-03 |