| NPI | 1508819244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4331/T1024) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1251DT) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2018-04-05 |