| NPI | 1770543720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT001327) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA GA1327) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2010-04-27 |