| NPI | 1982739595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002106) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC3796) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2022-09-07 |