| NPI | 1245213610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3937) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH T764) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2020-06-08 |