| NPI | 1366415663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4651) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH T1426) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2009-01-05 |