| NPI | 1346214848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH S291) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH T2200) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2013-09-16 |