| NPI | 1366453276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5482/t2394) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3040) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2010-08-20 |