| NPI | 1639518566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6198-T3113) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 6198-T3113) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2013-06-26 |