| NPI | 1437374659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1299) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5646T2560) |
| 152W00000X Optometrist (Licence: KY 1715DT) | |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2012-08-30 |