NPI | 1558329540 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OP02661) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OP02661) |
152WP0200X Optometrist, Pediatrics (Licence: FL OP02661) | |
Enumeration Date | 2006-05-02 |
Last Update Date | 2023-04-13 |