| NPI | 1891225066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-343-TA-D31) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003022) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2025-02-05 |