| NPI | 1063502565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC-1819) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: FL OPC-1819) |
| 171100000X Acupuncturist (Licence: FL AP466) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-07-04 |