| NPI | 1659411932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4274-T804) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 4274 - T804) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2024-02-06 |