| NPI | 1720047574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OP2683) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC 2683) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2021-07-22 |