| NPI | 1306972286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5453 T2365) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OFC 33) |
| 152W00000X Optometrist (Licence: CA 8976T) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2014-05-07 |