| NPI | 1366493413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 28019642) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3029T143) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2009-06-22 |