| NPI | 1013172238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA opt002479) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2829) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2023-09-12 |