| NPI | 1467856443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC6161) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8546T) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2022-09-07 |