| NPI | 1235198268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5516 T2428) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV0045221) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2016-12-20 |