| NPI | 1164263224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: OH OPT.007291) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.007291) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-06-03 |