| NPI | 1033129531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3928) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: OH 960T47) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2012-11-15 |