| NPI | 1952559684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 4373) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL S-B83-TA-797) |
| Enumeration Date | 2008-09-06 |
| Last Update Date | 2011-05-03 |