| NPI | 1720282775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 3866) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1276) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2010-05-05 |