| NPI | 1790595171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 2529) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 007348) |
| Enumeration Date | 2025-01-08 |
| Last Update Date | 2026-08-26 |