| NPI | 1356348437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: OH 4693/T1471) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: OH 4693/T1471) |
| 152WS0006X Optometrist, Sports Vision (Licence: OH 4693/T1471) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: OH 4693/T1471) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2022-03-22 |