| NPI | 1619003787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3859-T458) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: OH 3859-T458) |
| Enumeration Date | 2007-02-25 |
| Last Update Date | 2012-09-18 |