| NPI | 1356780670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2007DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6219) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2022-03-21 |