| NPI | 1578608717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 1578) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 1634) |
| 152W00000X Optometrist (Licence: TN 1791) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2014-10-22 |