| NPI | 1629451448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL opc5162) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 9410779-9934) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2019-02-13 |