| NPI | 1033117528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6173/T3088) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA1838) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2022-03-01 |