| NPI | 1508937079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1072DT) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: KY 1072DT) |
| 152W00000X Optometrist (Licence: IN 18002494A) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2023-04-26 |