| NPI | 1528145257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 2249) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002249) |
| 152W00000X Optometrist (Licence: FL 4033) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2014-01-08 |