| NPI | 1063844108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.006928) |
| Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: MI 4901004731) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2023-05-25 |