| NPI | 1538379011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT5688THER) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5688) |
| 152W00000X Optometrist (Licence: MI 4901004510) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2023-11-03 |