| NPI | 1184803397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC-4556) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL S-B73-TA-772) |
| 152W00000X Optometrist (Licence: WI 3124-35) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2010-11-11 |