| NPI | 1942588926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5041) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 1613-646T) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2019-10-22 |