| NPI | 1851671739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003143) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007779) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2023-11-01 |