| NPI | 1780990234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002609) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2952) |
| Enumeration Date | 2010-08-22 |
| Last Update Date | 2010-08-22 |