| NPI | 1780766824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R148TA685) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MS 791) |
| 152W00000X Optometrist (Licence: GA OPT002359) | |
| 152W00000X Optometrist (Licence: TN OD0000002785) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2014-03-14 |