| NPI | 1558474361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 2872) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: FL 2872) |
| 152WV0400X Optometrist Vision Therapy (Licence: FL 2872) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-11-12 |