| NPI | 1053302281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 2372) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 4116) |
| Enumeration Date | 2005-11-05 |
| Last Update Date | 2014-03-19 |