| NPI | 1629561204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.006652) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002372) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2025-11-19 |