| NPI | 1396150587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5044) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2426) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC5044) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2022-07-21 |