| NPI | 1699087437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID 100220) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5947) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2013-08-20 |