| NPI | 1831303643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 3342) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 5988 TUV) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2013-05-22 |