| NPI | 1104969161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 3163) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY tuv007654) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2017-03-10 |