| NPI | 1922395441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4657) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1646) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2017-08-03 |