| NPI | 1154457109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH T1404) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3768) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |