| NPI | 1003819830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OP 1619) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3454/T342) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2008-08-08 |