| NPI | 1073513099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0601800257) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 4876) |
| 152W00000X Optometrist (Licence: VA 0618001115) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2007-07-08 |