| NPI | 1508215203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6488) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: OH 6488) |
| 152WP0200X Optometrist, Pediatrics (Licence: OH 6488) | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2021-01-13 |