| NPI | 1477938520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP1000429) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5102) |
| 152W00000X Optometrist (Licence: MD TA2622) | |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2022-06-21 |