| NPI | 1568556132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1753DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5663) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-11-04 |