| NPI | 1891196903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4991) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 4991) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2020-06-16 |