| NPI | 1235443920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1879) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2010022260) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2018-09-25 |