| NPI | 1497784755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1011DT) |
| Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: KY 1011DT) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2011-02-14 |