| NPI | 1609878701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC3395) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL V00567) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2013-10-16 |