| NPI | 1306879853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: OH 3171) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: OH 3171) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2007-07-08 |