| NPI | 1386622777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 11473) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2183) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2009-09-24 |