| NPI | 1710192166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT000994) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 1730) |
| 152W00000X Optometrist (Licence: SC 710) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-07-08 |