| NPI | 1336224625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV NV189) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3542) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2008-02-20 |