| NPI | 1235707597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.007192) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5957) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2023-11-15 |