| NPI | 1669902094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003083) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5421) |
| 152W00000X Optometrist (Licence: NY TUV008589) | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-06-16 |