| NPI | 1982896593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1711DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2857) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2012-02-17 |