| NPI | 1447253885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100426) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3948/T1027) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2018-05-23 |