| NPI | 1518930064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2778) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5232) |
| 152W00000X Optometrist (Licence: OH T2136) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2021-06-14 |