| NPI | 1740662691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2443) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002870) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2018-03-17 |