| NPI | 1003887928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5557) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT.0003172) |
| 152W00000X Optometrist (Licence: FL 4032) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2021-10-25 |