| NPI | 1699889998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1621) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5615) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2016-07-26 |