| NPI | 1003899774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301064463) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4301064463) |
| Enumeration Date | 2005-11-27 |
| Last Update Date | 2016-12-20 |