| NPI | 1750428561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5150) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 507) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2016-03-08 |