| NPI | 1609150895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5027) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 56-007867) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2020-05-05 |