| NPI | 1649247503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4972/T1842) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 1792) |
| 152W00000X Optometrist (Licence: FL OPC 3519) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2016-12-29 |