| NPI | 1043380553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901002831) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901002831) |
| 152WP0200X Optometrist, Pediatrics (Licence: MI 4901002831) | |
| 152WS0006X Optometrist, Sports Vision (Licence: MI 4901002831) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2009-04-09 |