| NPI | 1285656553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 2712) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5712) |
| 152W00000X Optometrist (Licence: FL OPC2712) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-03-27 |