| NPI | 1487745949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AK 204) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5327 T2236) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2012-09-07 |