| NPI | 1487753141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT 002025) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC SC 1345) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2007-07-08 |