| NPI | 1669545042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3759T520) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 1226) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2013-09-05 |