| NPI | 1275848962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003759) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5936) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2018-08-14 |