| NPI | 1912011131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN T2666) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002434) |
| 152W00000X Optometrist (Licence: KY 1687DT) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2023-02-12 |