| NPI | 1922532811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPFC97) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 2042) |
| 152W00000X Optometrist (Licence: OK 2929) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2020-08-28 |