| NPI | 1710964077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2774) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2053DT) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: KY 2053DT) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2024-04-24 |