| NPI | 1750322368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL opc2898) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL opc2898) |
| 152WS0006X Optometrist, Sports Vision (Licence: FL ob2475) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-02-13 |