| NPI | 1518527274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5781) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003587) |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2022-12-26 |