| NPI | 1790709699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 3355) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: FL OPC 3355) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC 3355) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: VA 0618001596) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: FL OPC 3355) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: VA 0618001596) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: VA 0618001596) | |
| 152WP0200X Optometrist, Pediatrics (Licence: VA 0618001596) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: FL OPC 3355) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-02-17 |