| NPI | 1114300472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5272) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: TN 3237) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2022-07-21 |