| NPI | 1922413558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPFC96) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008192-1) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2020-02-27 |