| NPI | 1770838732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1905DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003740A) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2022-07-28 |