| NPI | 1437187242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 3180) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TN 1694) |
| 152WX0102X Optometrist, Occupational Vision (Licence: FL opc-3180) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2007-07-08 |