| NPI | 1427188218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4228) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2682) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2012-06-06 |