| NPI | 1285865139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003943A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5878) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2016-09-13 |