| NPI | 1568426625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1503-3) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: KS 1503-3) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2017-05-10 |