| NPI | 1629065149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2997) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 4924/T1794) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 4924/T1794) | |
| 152WP0200X Optometrist, Pediatrics (Licence: OH 4924/T1794) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: OH 4924/T1794) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2025-06-23 |