| NPI | 1740340967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2508) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: FL OPC2508) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2016-11-17 |