| NPI | 1396731477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 4152) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009644) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2012-08-13 |