| NPI | 1760512388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4499t1155) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG000203) |
| 152W00000X Optometrist (Licence: GA OPT001415) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2024-11-19 |