| NPI | 1316370414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL applying) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4882) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2024-11-27 |