| NPI | 1790097590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5937) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 618002038) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2020-09-24 |