| NPI | 1023366531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC004766) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002167) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2014-03-12 |