| NPI | 1912041302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 3856) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4409) |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2007-07-08 |