| NPI | 1124351937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4461) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT2551) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2017-04-21 |