| NPI | 1730181967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 37261) |
| Additional Taxonomies | 152WX0102X Optometrist Occupational Vision (Licence: KY 37261) |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: KY 37261) | |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: KY 37261) | |
| 152WP0200X Optometrist Pediatrics (Licence: KY 37261) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2010-04-26 |