| NPI | 1013291566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4665) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002557) |
| 152W00000X Optometrist (Licence: NY TUV007963) | |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2016-09-27 |