| NPI | 1588769848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD 0000000546) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT 001596) |
| 152W00000X Optometrist (Licence: SC 1494) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2011-10-06 |