| NPI | 1679573216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3411-t459) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 3411-T459) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2008-03-24 |