| NPI | 1215957212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1641DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003342) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-09 |