| NPI | 1497896443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4343) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009633) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: IL 046-009633) | |
| 152WP0200X Optometrist, Pediatrics (Licence: IL 046-009633) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC4343) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: FL OPC4343) | |
| 152WP0200X Optometrist, Pediatrics (Licence: FL OPC4343) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2009-04-25 |