| NPI | 1750180212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2868) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.007378) |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2025-11-10 |