| NPI | 1184734394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 3825) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 06478T) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-04-30 |