| NPI | 1447735147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3800) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 2311) |
| 152W00000X Optometrist (Licence: GA OPT003129) | |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2023-07-05 |