| NPI | 1609801463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.007097) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 0915DT) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-09-09 |