| NPI | 1477557148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD0000000843) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT000958) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2023-03-07 |