| NPI | 1891757704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1116-3) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1116-2) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2016-12-05 |