| NPI | 1356385587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6651 T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 3947) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2007-07-09 |