| NPI | 1083624878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC3380) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 06362T) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2011-11-07 |