| NPI | 1528119245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002180) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 002180) |
| 152W00000X Optometrist (Licence: IN 18003283A) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2014-09-02 |