| NPI | 1174597934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1073DT) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 1073DT) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2023-03-07 |