| NPI | 1760793251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6006 T2921) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003633A) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2024-04-12 |