| NPI | 1235552142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 4896) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PR 703-320) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2022-12-12 |