| NPI | 1326045618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ A805) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL FLA2564) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2009-02-03 |