| NPI | 1548572811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1886) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2010020777) |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: KS 1886) | |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2018-06-29 |