| NPI | 1730539461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2264DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN ODT3416) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2022-01-26 |