| NPI | 1952307084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2214) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA0943) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2023-10-26 |