| NPI | 1013900265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1023DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3691/T190) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2008-03-04 |