| NPI | 1457467532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC3739) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11485T) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-07-09 |