| NPI | 1598783235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 4173) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002256) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-08-04 |