| NPI | 1144267105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 1363) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT001274) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2024-05-02 |