| NPI | 1588096432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2832) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1937DT) |
| 152W00000X Optometrist (Licence: IN 18003816A) | |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2022-07-27 |