| NPI | 1942372917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WS0006X Optometrist, Sports Vision (Licence: FL OPC 3568) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 3568) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC 3568) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2025-09-11 |