| NPI | 1922086396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10157) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.4824-THER) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2021-05-28 |