| NPI | 1548666076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1972DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003877A) |
| Enumeration Date | 2014-11-11 |
| Last Update Date | 2016-12-02 |