| NPI | 1386749083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3772T1192) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 787) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |