| NPI | 1912996984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2129) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4007) |
| 152W00000X Optometrist (Licence: HI 740) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2013-07-22 |