| NPI | 1497060362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002739) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2201) |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2013-02-08 |