| NPI | 1134209901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1735) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2005027604) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2023-03-20 |