| NPI | 1366891582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPT 5192) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 2095) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-12-06 |