| NPI | 1457648842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL T-228-TA-A55) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6064) |
| 152W00000X Optometrist (Licence: OH T2979) | |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2016-08-12 |