| NPI | 1871682617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OH3369) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OH3369/T619) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH OH3369/T619) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2012-02-13 |