| NPI | 1932529310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5017) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002887) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2015-06-04 |