| NPI | 1710022710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 0827DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001530) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |