| NPI | 1285997072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002150) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 4846) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2016-02-05 |