| NPI | 1518945179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 3456) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: FL OPC3456) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC3456) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2019-08-09 |