| NPI | 1689057366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5084) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL R-298-TA-C19) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2023-05-15 |