| NPI | 1275939100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4993) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002967) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2023-03-09 |