| NPI | 1205907565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003563) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: AL R-214) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2024-07-29 |