| NPI | 1770861650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN TN 3152) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 2714) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2016-11-10 |