| NPI | 1346654498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6265) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1952DT) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2015-06-26 |