| NPI | 1275781841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5820 T2734) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4380) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2023-09-25 |