| NPI | 1215093760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 960DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18001993) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2009-04-23 |