| NPI | 1043252893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5915) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WV 988-OD) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2022-03-23 |