| NPI | 1740803766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.7001) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MS 1001) |
| 152W00000X Optometrist (Licence: TN 3572) | |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2021-08-18 |