| NPI | 1972656692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1381) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3760) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2018-04-19 |