| NPI | 1265969109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.006705) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5402) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2019-06-18 |