| NPI | 1528245180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-A39-TA-599) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002051) |
| 152W00000X Optometrist (Licence: OK 2323) | |
| 152W00000X Optometrist (Licence: TN 2235) | |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2014-12-17 |