| NPI | 1194207662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-E18-TA-B35) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003122) |
| 152W00000X Optometrist (Licence: FL OPC5588) | |
| Enumeration Date | 2018-08-31 |
| Last Update Date | 2018-08-31 |