| NPI | 1073568010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3418/T493) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1448DT) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2009-03-30 |