| NPI | 1083771133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 3761) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009327) |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2023-03-07 |