| NPI | 1942457775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2124) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2831) |
| 152W00000X Optometrist (Licence: GA OPT002640) | |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2016-06-16 |