| NPI | 1194722819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1097DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003162A) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2010-06-14 |