| NPI | 1891159356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5629) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 2102) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2020-01-14 |