| NPI | 1023469046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OFC 79) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT. 6504) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2017-02-21 |