| NPI | 1174677066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18001803A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 4807T1649) |
| 152W00000X Optometrist (Licence: KY 0880DT) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |