| NPI | 1609989995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4229) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GU 35) |
| 152W00000X Optometrist (Licence: CO 1659) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2022-07-21 |