| NPI | 1457450850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5424) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 5424) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: OH 5424) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-09-06 |