| NPI | 1497891378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3361) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH T551) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2008-08-25 |