| NPI | 1093206096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 096356) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.006657) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: IA 096356) | |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2019-08-06 |