| NPI | 1417640194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 3210) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.007171) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2023-08-08 |