| NPI | 1538401476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5458) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1768) |
| 152W00000X Optometrist (Licence: TN 3128) | |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2018-03-17 |