| NPI | 1700863214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1403DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003024A) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2014-12-22 |