| NPI | 1295177152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2138DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WV 2001-IOD1) |
| Enumeration Date | 2013-07-20 |
| Last Update Date | 2019-09-03 |