| NPI | 1528250792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1726DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5758) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2008-07-01 |