| NPI | 1205876919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2136) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 1093) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-07-17 |