| NPI | 1912088105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2707) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OP2707) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-08-12 |