| NPI | 1386909729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4973) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2342) |
| 152W00000X Optometrist (Licence: MI 4901004719) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2019-04-29 |