| NPI | 1831286582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5550 T2464) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001739) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2007-07-08 |