| NPI | 1245228592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R133TA477) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT-001821) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2022-03-03 |