NPI | 1679096812 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2080DT) |
Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: KY 2080DT) |
Enumeration Date | 2017-07-19 |
Last Update Date | 2022-07-21 |