| NPI | 1578016184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3735) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.6498) |
| Enumeration Date | 2016-07-31 |
| Last Update Date | 2024-05-29 |