| NPI | 1861986358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.006934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AR 2773) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2022-08-31 |