| NPI | 1083092126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1975DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8434T) |
| 152W00000X Optometrist (Licence: IN 18003891A) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2020-04-16 |