| NPI | 1922036458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 2436) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: FL OPC2436) |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: FL 2436) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2022-04-21 |