| NPI | 1164137246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18004468A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.007131) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2024-06-09 |