| NPI | 1629209531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 4449) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002251) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2009-10-27 |