| NPI | 1801231279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002715) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 001734) |
| 152W00000X Optometrist (Licence: GA 00996) | |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2013-04-30 |