| NPI | 1821175373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5499) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2479DT) |
| 152W00000X Optometrist (Licence: GA OPT003636) | |
| 152W00000X Optometrist (Licence: FL OPC6609) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2026-07-02 |