| NPI | 1477968196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6527) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003853) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2018-08-15 |