| NPI | 1396483020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.007034) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2282DT) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2022-08-10 |