| NPI | 1285856757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1103) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2268DT) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2024-08-27 |