| NPI | 1740290881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN ODT940) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1062DT) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2008-02-19 |