| NPI | 1447823158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 3246) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.007125) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2023-05-17 |