| NPI | 1134435514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OFC 76) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV-007600-1) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2017-04-06 |