| NPI | 1528178928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002317) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL SA53TA638) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-07-24 |