| NPI | 1205035037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003539A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5698) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2014-09-09 |