| NPI | 1043272966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT 000916) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO T02447) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-07-08 |