| NPI | 1316250459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1880DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2659) |
| 152W00000X Optometrist (Licence: AR 2665) | |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2012-10-22 |