| NPI | 1235226085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3248-T514) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3248) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2017-03-09 |