| NPI | 1265623086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4244) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007163) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2010-10-07 |