NPI | 1265536403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5055) |
Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: OH 5055) |
152WS0006X Optometrist, Sports Vision (Licence: OH 5055) | |
152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 5055) | |
Enumeration Date | 2006-09-08 |
Last Update Date | 2024-03-11 |