| NPI | 1689715740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 5342 T2251) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.005342) |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2024-04-29 |