| NPI | 1902941180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1735) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5358) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2022-08-15 |