| NPI | 1497827455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY Mark823) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 823) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2008-09-08 |