| NPI | 1306295894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18004064) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.6497) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2025-10-14 |