| NPI | 1124320817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004866) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901004866) |
| 152WP0200X Optometrist, Pediatrics (Licence: MI 4901004866) | |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2021-08-18 |