| NPI | 1013017656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5627) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 5627) |
| 152WP0200X Optometrist, Pediatrics (Licence: OH 5627) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2023-08-29 |