| NPI | 1518702562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003592) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC6621) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2025-11-20 |