| NPI | 1972665883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2385) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: FL OPC2385) |
| 152W00000X Optometrist (Licence: CA 8843-T) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2016-04-09 |