| NPI | 1497889711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5444) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1606DT) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2013-06-04 |