| NPI | 1245722917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5553) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC005553) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2022-08-15 |