| NPI | 1255781647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 2039) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: KS 2039) |
| 152WP0200X Optometrist, Pediatrics (Licence: KS 2039) | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2020-10-13 |