| NPI | 1427313568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2464) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002704) |
| 152W00000X Optometrist (Licence: FL OPC4879) | |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2023-01-10 |