| NPI | 1619910569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1293DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1454) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: KS KS1454) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-11-28 |