| NPI | 1013928480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3892) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901003796) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2016-08-30 |