| NPI | 1194815811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002250) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL opc3570) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2014-02-12 |