| NPI | 1730495805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1925) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 4562) |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2019-01-24 |