| NPI | 1356832380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2165DT) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH OPT.006640) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2024-03-14 |