| NPI | 1528190527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618003350) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OH5283) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2023-11-15 |