| NPI | 1033294111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4668) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 5255) |
| 152W00000X Optometrist (Licence: NJ 5155) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2019-12-04 |