| NPI | 1396125183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2453) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: CA OPT15457 TLG) |
| 152W00000X Optometrist (Licence: OH OPT6361) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2023-07-11 |