| NPI | 1073539870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4913) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OH 4913) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-01-13 |