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 | 2025-10-02 |