| NPI | 1619191368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3451T444) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 3451 T444) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2019-12-04 |