| NPI | 1447818752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5894) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003740) |
| 152W00000X Optometrist (Licence: TX 11652) | |
| 152W00000X Optometrist (Licence: VA 0618002761) | |
| Enumeration Date | 2019-06-01 |
| Last Update Date | 2026-07-21 |