| NPI | 1245527654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.006093) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002472) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2020-02-21 |