| 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 |