| NPI | 1982714614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-B47-TA-739) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4178) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-11-05 |