| NPI | 1841325669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4964) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH T1834) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2016-09-18 |