| NPI | 1932191756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC001061) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: FL OPC001061) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2010-10-11 |