| NPI | 1659468502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5199) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH T2103) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-04-29 |