| NPI | 1578531091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL opc 2599) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: FL opc 2599) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2014-11-07 |