| NPI | 1194461699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 2435) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 134554) |
| 152W00000X Optometrist (Licence: OH OPT.007085) | |
| Enumeration Date | 2022-05-07 |
| Last Update Date | 2025-09-22 |