| NPI | 1396934485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: KY 1713DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1713DT) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: KY 1713DT) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2007-10-15 |