| NPI | 1316202401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4785) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: VA 0618002165) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2017-03-27 |