| NPI | 1881841492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4384) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001793) |
| 152W00000X Optometrist (Licence: MD TA2116) | |
| 152W00000X Optometrist (Licence: PA OEG002140) | |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2022-11-08 |