| NPI | 1245016047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 007255) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 10989) |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2024-08-19 |