| NPI | 1306860754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4193T1387) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: OH 4193T1387) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 4193T1387) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2017-06-30 |