| NPI | 1821090614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 2756 T356) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 2756 T356) |
| 152WS0006X Optometrist, Sports Vision (Licence: OH 2756 T356) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2010-06-17 |