| NPI | 1306095716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5790/T2704) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1741DT) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2021-05-03 |