| NPI | 1255567293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1948DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2876) |
| 152W00000X Optometrist (Licence: OH 5868) | |
| 152W00000X Optometrist (Licence: OH T2782) | |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2014-07-21 |