| NPI | 1700867652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.007031) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-008206) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2024-01-03 |