| NPI | 1932103439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 1946) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5463) |
| 152WP0200X Optometrist Pediatrics (Licence: NC 1946) | |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: NC 1946) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2010-09-13 |