| NPI | 1144364043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT001400) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL S-779-TA-718) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2024-05-23 |