| NPI | 1831538727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6216) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3307-035) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2019-03-12 |