| NPI | 1821090184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WV 797-OD) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3766) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2008-08-19 |