| NPI | 1114922127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 2908 T455) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 2908/T455) |
| 152WS0006X Optometrist, Sports Vision (Licence: OH 2908/T455) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2016-01-08 |