| NPI | 1598020422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1887DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003736A) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2014-02-19 |