| NPI | 1144584160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: FL OPC4789) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: MO 2012020517) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2013-08-09 |