| NPI | 1841341971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003218) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 1949) |
| 152W00000X Optometrist (Licence: NC 1160) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-03-02 |