| NPI | 1437397866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4357) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001780) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2012-07-18 |