NPI | 1821833187 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003595) |
Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC6510) |
Enumeration Date | 2024-06-28 |
Last Update Date | 2024-07-30 |