| NPI | 1962567511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 821DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 0821DT) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2009-07-29 |