| NPI | 1518043132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1045DT) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: KY 1045DT) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2016-09-23 |