| NPI | 1285625780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT1060) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: GA 005552) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2020-04-16 |