| NPI | 1366533036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OH4565) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.004565) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2025-12-29 |