| NPI | 1659993541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.006844) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 2298) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2025-08-28 |