| NPI | 1073180741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003364) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: AL S-E78) |
| 152WX0102X Optometrist, Occupational Vision (Licence: AL S-E78-TA-C17) | |
| 152W00000X Optometrist (Licence: AL S-E78) | |
| 152W00000X Optometrist (Licence: AL S-E78-TA-C17) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: AL S-E78) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: AL S-E78-TA-C17) | |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2024-07-22 |