| NPI | 1316291206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC OPT2182) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4755) |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2021-03-03 |