| NPI | 1659378461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1519-3) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO T03413) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2017-07-05 |