| NPI | 1316942352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management (Licence: OH 3590) |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: OH 3590) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2009-08-11 |