| NPI | 1336249705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3026/T446) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1284) |
| 152W00000X Optometrist (Licence: GA OPT002093) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2008-08-21 |