| NPI | 1639306053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1669) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1813DT) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2020-10-22 |