| NPI | 1164673174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1822) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT.0002676) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2019-06-12 |