| NPI | 1508921164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1189DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18002460) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-09 |