| NPI | 1447239264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT006518) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2764) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2021-03-16 |