| NPI | 1669432969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 3957) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: FL OPC 3957) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2023-02-26 |