| NPI | 1174561989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TN MD43496) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 057529) |
| 152W00000X Optometrist (Licence: TN MD43496) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2022-03-23 |