| NPI | 1902903511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1676DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2659) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2019-12-03 |