| NPI | 1487663365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4165/T097) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1175DT) |
| 152W00000X Optometrist (Licence: IN 18002498) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2023-03-20 |