| NPI | 1356743272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: FL OPC 4280) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 4280) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2014-09-23 |