| NPI | 1366530727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 4290) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2003) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2011-01-13 |