| NPI | 1487961967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002226) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4525) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2023-10-25 |