| NPI | 1093400269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WX0102X Optometrist, Occupational Vision (Licence: KY 2311DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2311DT) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2023-04-05 |