| NPI | 1326040536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 2117) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 4531 T1261) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2022-12-14 |