| NPI | 1518088921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN ODT698) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 920T) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |