| NPI | 1700948197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.004062) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 4062-T1641) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2026-01-20 |