| NPI | 1346892627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 1005) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003183) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2020-10-08 |