| NPI | 1770688715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 3952) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA1872) |
| 152W00000X Optometrist (Licence: PA OEG0001390) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2016-09-12 |