| NPI | 1386059566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5008) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2419) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2015-05-24 |