| NPI | 1437160801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1598DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN TN0000002569) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2013-08-05 |