| NPI | 1487776324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5308 T2217) |
| Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy (Licence: OH 03225298) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2017-09-05 |