| NPI | 1568516458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4668T1443) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 1669) |
| 152W00000X Optometrist (Licence: IN 18004385A) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2024-04-03 |