| NPI | 1821439878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6225) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1799) |
| Enumeration Date | 2013-07-07 |
| Last Update Date | 2018-04-19 |