| NPI | 1831281856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6277) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WV 599OD) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2015-09-16 |