NPI | 1265425755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC001391) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC001391) |
Enumeration Date | 2005-08-30 |
Last Update Date | 2020-08-27 |