| NPI | 1629132774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2777) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0601001988) |
| 152W00000X Optometrist (Licence: WA OD00004116) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-07-08 |