| NPI | 1780412957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC6592) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2416DT) |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-12-19 |