| NPI | 1134656366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV008739-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.6572) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2023-06-26 |