| NPI | 1306083787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 004330) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2116) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2021-04-13 |