| NPI | 1497900070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1775DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008252) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2015-07-21 |