| NPI | 1487151403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 4093) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004089A) |
| 152W00000X Optometrist (Licence: OH OPT.006738) | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2025-09-08 |