| NPI | 1326025743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 71393) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 22111) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2024-02-14 |