| NPI | 1235668138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2167DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9306T) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2021-04-16 |