| NPI | 1710268206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.007122) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 15382) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2023-07-13 |