| NPI | 1023248952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1871) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5911) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2013-04-17 |