| NPI | 1528231958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC3154) |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: FL OPC3154) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2008-04-07 |