| NPI | 1871637827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 3735) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OB 3089) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2010-08-18 |