| NPI | 1760898233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6312) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: OH 6312) |
| Enumeration Date | 2014-07-06 |
| Last Update Date | 2020-04-09 |