| NPI | 1952410532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.004131) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 4131/T1002) |
| 152W00000X Optometrist (Licence: KY 1443DT) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-02-16 |