| NPI | 1295894533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2182) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT001101) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2009-12-28 |