| NPI | 1346216546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002932) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1401) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2022-10-20 |