| NPI | 1538325832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1800) |
| Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: KS 1800) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2013-02-05 |