| NPI | 1649968918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2381DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC6260) |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2024-12-16 |