| NPI | 1821657198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.006800) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6800) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2021-04-26 |