| NPI | 1043290893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4977 1847T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12081T) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2025-11-24 |