| NPI | 1275017451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.006700) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6700) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2020-11-21 |