| NPI | 1407892888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.005255) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1535) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: KY 1535T) | |
| 152W00000X Optometrist (Licence: OH 5355) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-08-09 |