| NPI | 1194727743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1055DT) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IN 18002127B) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: KY 1055DT) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2023-02-13 |