| NPI | 1558591321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5839) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1831DT) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2017-03-19 |