| NPI | 1760441828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 834) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 4435 T1159) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2012-10-31 |