| NPI | 1871788141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4466) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1716DT) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2014-03-28 |