| NPI | 1841262755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S904TA468) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA GAOPT-001696) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2008-01-03 |