| NPI | 1023225075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1785DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1373) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2019-06-26 |