| NPI | 1205232444 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 2966) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002848) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2025-01-29 |