| NPI | 1821139080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT001074) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH012110) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2013-06-05 |